MEDICARE: SIERRA SOCIAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1538600689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA SOCIAL SERVICES

Provider Business Mailing Address
First Line	:	15 HILL RD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-4603
Country	:	US
Telephone Number	:	732-423-5397
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 HILL RD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-4603
Country	:	US
Telephone Number	:	732-423-5397
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	MOHAMED T FOFANAH
Credential	:
Telephone Number	:	732-423-5397

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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Directions to “SIERRA SOCIAL SERVICES ” Practice Location

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